The way you’ll report acetaminophen, denosumab, and immune globulin in 2012 is going to change, and if you don’t stay on top of the changes, you could be missing out on your pay. Look out for administration methods for Ofirmev and Gamunex-C especially.
A New Addition for Acetaminophen: J0131
HCPCS 2012 adds J0131 (Injection, acetaminophen, 10 mg) for reporting acetaminophen administered by infusion. The brand name for this injectable form is Ofirmev.
Physicians may order the drug “for the management of mild to moderate pain; management of moderate to severe pain with adjunctive opoid analgesics; and for fever reduction in adults and children 2 years or older,” according to the May 17, 2011, HCPCS Public Meeting Agenda (www.cms.gov/MedHCPCSGenInfo/downloads/Tues_May17thDrug-Agenda.pdf).
Example: Staff administers 1000 mg of Ofirmev over 15 minutes. You should report J0131 x 100 units (1000 mg administered divided by the 10 mg in the definition). For the administration, report 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug).
More Specific Code for Prolia and Xgeva
As of Jan. 1, 2012, you’ll be able to report denosumab with ease using new code J0897 (Injection, denosumab, 1 mg). This antibody works by decreasing bone resorption and increasing bone density. Brand names for denosumab include Prolia and Xgeva.
Prolia is indicated to increase bone mass in individuals at high fracture risk due to certain cancer therapies, specifically in men receiving androgen deprivation therapy to treat nonmetastatic prostate cancer and also in women with breast cancer who receive adjuvant aromatase inhibitor therapy. Xgeva is intended for “prevention of skeletal-related events (SREs) in patients with bone metastases from solid tumors,” the HCPCS agenda states. In 2011, denosumab didn’t have a specific HCPCS code...
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